Characteristics and HIV-related Engagement of Male Sexual Partners of Female Sex Workers in Sub-Saharan Africa (SSA): a Scoping Review

IntroductionUnderstanding the characteristics and behaviors of male sexual partners of female sex workers (FSWs) is crucial for comprehending the dynamics of HIV transmission. We aimed to explore and quantify the existing literature on male sexual partners of FSWs in SSA, where HIV prevalence is high and the dynamics of sex work are poorly understood. We focused on the proportions of men reporting sex with FSWs, along with their characteristics, HIV prevalence, and engagement with HIV services among the general population and specific subgroups. MethodsWe searched the literature in the EBSCOhost databases (Medline Complete, Global Health, and CINAHL). We included quantitative epidemiological peer-reviewed articles published in English between January 2010 and December 2023, following PRISMA guidelines for scoping reviews. The last search was performed on 09 October 2024. Eligible studies focused on men from the general population and subgroups of men who reported having sex with FSWs. The results were synthesized narratively to identify patterns and gaps in the literature. ResultsWe identified 2,067 articles and reviewed 15, including one meta-analysis. The general population meta-analysis and the articles among subgroups revealed variations in reporting sex with FSWs, differences in HIV prevalence, suboptimal HIV testing uptake, and inconsistent condom use. The proportion of general population men in SSA who had ever paid for sex was 8.5%, with a pooled HIV prevalence of 3.6% and 67.5% reported condom use at last paid sex. High-risk subgroups of men reported different rates of sex with FSWs, ranging from 6.6% to 74%. HIV prevalence also varied significantly, from 7.5% to 26%. Across these high-risk groups, suboptimal HIV testing uptake and inconsistent condom use were common, with no comparative data for men who did not have sex with FSWs. DiscussionMen who have sex with FSWs cannot be identified by specific characteristics. High-risk subgroups reported greater engagement with FSWs. Sex with an FSW was associated with higher HIV prevalence among men in the general population, with no data on subgroups. These findings highlight the need for tailored, occupation-specific interventions that address the unique needs of mobile and high-risk men.